Fraction of exhaled nitric oxide as a predictor in juvenile idiopathic arthritis progression

PubMedID: 27511473In this study, the relation between the nitric oxide (NO) levels in the serum and fraction of exhaled nitric oxide (FENO) in children with juvenile idiopathic arthritis (JIA) and the activation criteria of the disease has been investigated. The study group consisted of 35 JIA-diagnosed patients and 18 healthy children. According to the clinical and laboratory findings, the patients with JIA were divided into two groups, active (group I) and in remission (group II). The healthy children were classified as group III. The activation criteria of the disease were determined for each patient. The serum NO level and FENO level were measured in all the patients. In the group with JIA, correlation was detected between FENO level and number of involved joints and number of joints with limited motion. In addition, correlation was determined between the FENO level and number of involved joints in group I and the serum NO level and activity score in group II. However, it was seen that there is no statistical difference in the serum NO level and FENO level of the patients with JIA and the control group and groups I and II. This study demonstrated the correlation between FENO level and number of involved joints and number of joints with limited motion in patients with JIA. Our results matter in terms of FENO being a noninvasive laboratory marker in following the progression of the disease. © 2016, International League of Associations for Rheumatology (ILAR)

Life-threatening facial edema due to pine caterpillar mimicking an allergic event

PubMedID: 16854350Background: Approximately 150 species of Lepidoptera have been described as causing damage to human skin. One of these species is the pine processionary caterpillar, which is responsible for dermatitis, contact urticaria, ocular lesions and rarely respiratory signs and anaphylactic reactions through IgE-mediated or non-IgE-mediated mechanisms. We report a pediatric case of severe orofacial edema mimicking an allergic reaction after ingestion of a pine processionary caterpillar; urgent airway intubation was required. Case report: A 15-month-old boy was sleeping under a pine tree when his mother noted a pine caterpillar on his tongue. Because of rapidly developing facial swelling and respiratory distress, the infant was first taken to a local hospital where he received intravenous dexamethasone and pheniramine hydrogen maleate. On arrival at our emergency department, diffuse swelling and edema involving the tongue, perioral, nasal and perimandibular regions, and neck was noted, requiring urgent orotracheal intubation. There were no findings of anaphylaxis. The results of skin prick tests and specific IgE to common aero- and food allergens were negative. A skin prick test with extract of pine caterpillar was also negative. Prednisolone and pheniramine hydrogen maleate were administered for 7 days. The child gradually improved and was successfully extubated 4 days later. Conclusion: Although oral contact with a pine processionary caterpillar in the form of ingestion is rare, it may cause significant local reaction and airway compromise mimicking an allergic event. In this situation, early intubation to maintain airway patency is a life-saving measure

Atopy prevalance in children with cystic fibrosis

Purpose: It is known that genetic and geographic factors have significant roles in the expression of the clinical phenotype in cystic fibrosis. Another factor which may also be significant in determination of phenotype is coexistence of atopy. We aimed to investigate the frequency of atopy in children with cystic fibrosis who have been regularly followed up in our department. Methods: Total IgE, CAP-System FEIA (fluoroenzyme immunosorbent assay) and skin prick tests to common allergens were performed in children with cystic fibrosis who have symptoms of disease and whose sweat chloride level has been found greater than 60 mmol/L in two different times. FEV1 (forced expiratory volume in one second) values with spirometry and Shwachman-Kulczycki score were also recorded. Results: Forty patients aged between 1 and 20 years; mean 11 years were included to the study. Total IgE levels were between 17.6-2225 (median 376.7) IU/ml. CAP-System FEIA was found positive in five patients. One or more skin prick test results to common allergens were positive in four (10%) patients. All four patients with positive skin prick tests had also positive results for CAP-System FEIA. Only one patient with positive IgE-FEIA, did not show any positive reaction to skin prick tests. Mean Shwachman-Kulczycki score was 73.2 ± 11.0. There was no statistically significant difference between mean values of Shwachman-Kulczycki score of atopic and nonatopic patients. Conclusion: Atopy prevalance of Turkish children with cystic fibrosis as 10% is no more than the general population. Additionally, there is no correlation between the existence of atopy and Shwachman-Kulczycki score or FEV1 measurements. Further studies with larger series and follow up are needed to determine the role of atopy in the expression of the phenotype in cystic fibrosis

The prevalence of asthma and allergic diseases in children of school age in Adana in Southern Turkey

PubMedID: 15503474The aim of this study was to determine the prevalence of asthma and other allergic disorders as well as the factors affecting these disorders in school-children in Adana. This cross-sectional population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was carried out on 3164 school-children aged between 6-18 years during March to June 1997. There were 1521 (48.1%) boys and 1643 (51.9%) girls. The prevalence of asthma, allergic rhinitis and eczema in the 6-18 year-old children was found to be 12.6%, 13.6% and 8.3%, respectively. The prevalence of asthma was highest in 6-10 year-old school-children (14.7%), and lowest (6.0%) in 15-18 year-old children. The prevalence of asthma diagnosed by a doctor was 5.0%. The cumulative and current prevalences of wheezing were found to be 19.0% and 13.5%, respectively. The cumulative prevalence of allergic disorders was found to be 23.4%. The presence of domestic animals at home and dampness of the home were found to be important risk factors for asthma. Family histories of asthma, eczema, and diagnosis made by a doctor, and history of frequent sinusitis were found to be significantly higher in asthmatics. In conclusion, asthma is an important chronic disease of childhood in Adana in southern Turkey

Evaluation of efficacy of immunotherapy in children with asthma monosensitized to Alternaria

PubMedID: 21980810In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children monosensitized to Alternaria. Sixteen children with bronchial asthma monosensitized to Alternaria were enrolled in the study. Patients were divided into two groups as the immunotherapy group (Group I; 9 patients) and control group (Group II; 7 patients). A significant reduction in bronchial responsiveness to methacholine and Alternaria was found in Group I after one year of SIT (p=0.03, p=0.006) in comparison to controls. Specific IgE levels were decreased in the immunotherapy group (p=0.001). Following allergen provocation, a rise in sputum eosinophil count was found to be lower in the SIT group compared to controls after one year (p=0.011), and sputum eosinophil cationic protein (ECP) levels did not change in the SIT group, while there was a statistically significant increase in controls. Our results demonstrated that SIT with Alternaria caused clear changes in airway responsiveness and serum-specific IgE levels. However, further long-term studies in large series should be carried out for clinical documentation of the efficacy of SIT in the treatment of children with Alternaria allergy

Exposure to house dust endotoxin and allergic sensitization in allergic and nonallergic children living in Adana, Turkey

PubMedID: 19817265It has been suggested that exposure to elevated levels of endotoxin decreases the risk of allergic sensitization. The objective of our study was to analyze associations between house dust endotoxin levels and allergic sensitization in children. One hundred children with self-reported allergic diseases and 100 healthy children were randomly selected from a list of a previous prevalence study in school children. These children attended the study center again to complete a detailed questionnaire and medical examination including skin prick test and pulmonary function test. Of these children, 65 had allergen sensitization. Parents of a total 100 children (50 allergic and 50 healthy) agreed to house dust sampling in their homes. Thirty-five allergic children had asthma and 25 had rhinitis. Thirteen allergic and 14 healthy children lived in rural areas. The endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate test. Endotoxin was at a detectable level in all dust samples. Endotoxin levels ranged from 0.05 to 309 EU/ml, with a geometric mean of 61.8 (confidence interval [CI] %) (50-73) EU/ml. There were no differences in house dust endotoxin levels between allergic and nonallergic children (p=0.153). On the whole, the mean level of endotoxin in rural homes was higher than that of urban homes, but this was not statistically significant (p=0.354). The highest endotoxin level was found in the homes of nonallergic children living in the rural areas and the lowest level in the homes of allergic children living in an urban area; however, this was not important statistically (p=0.320). Exposure to endotoxin was not associated with a risk of allergic sensitization (odds ratio [OR]=0.98; 95% CI: 0.91-1.05, p=0.609). In conclusion, supposing that the current level of endotoxin may reflect that in the past, the levels of endotoxin in living room floor dust of homes of allergic and nonallergic children in our study population were not associated with allergic sensitization. Further studies are needed on this topic

The effects of meteorological factors and Alternaria spore concentrations on children sensitised to Alternaria

PubMedID: 20089344Background: Alternaria is the most important fungal species belonging to the class Deuteromycetes which causes allergic respiratory diseases. The fungus pattern often shows a pronounced seasonal periodicity and with fluctuations related to meteorological conditions. In this study, we aimed to investigate the effect of outdoor Alternaria spore concentrations on monthly lung function tests, symptoms, and medication scores in children sensitised only to Alternaria. Additionally, we planned to determine the Alternaria spores of the outdoor environment in Adana, with special respect to their relationships with meteorological conditions and their seasonal changes. Methods: Twenty-five patients with a clinical diagnosis of asthma and/or rhinitis sensitised only to Alternaria were enrolled in the prospective study. Meteorological data and outdoor samples of airborne fungi were obtained between November 2006 and October 2007. Results: The outdoor Alternaria spore concentrations were significantly correlated with the monthly average temperature (r=0.626, p=0.03) and monthly average barometric pressure (r=-0.613, p=0.03). Similarly, the outdoor Alternaria spore concentrations were significantly correlated with mean monthly asthma medication score (r=0.599, p=0.04), value monthly PEF (r=-0.737, p=0.006), value monthly FEF25-75% (r=-0.914, p=0.0001) and, variation in PEF (r=0.901, p=0.0001). Conclusions: The atmospheric concentration of Alternaria spores are markedly affected by meteorological factors such as air temperatures and barometric pressures. In hypersensitive patients, Alternaria spores can induce decreases in respiratory functions and development of allergic symptoms between May and September, being especially more influential in August. © 2009 SEICAP